Basic Surgery (100q).1
Settings
.
- 1.
- A.
Lean body mass increases.
- B.
Total body water increases.
- C.
Adipose tissue decreases.
- D.
Body weight decreases.
- 2.The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
- A.
Hypermetabolism.
- B.
Fever
- C.
Tachypnea
- D.
Hyperphagia
- E.
Negative nitrogen balance.
- 3.Shock can best be defined as:
- A.
Hypotension
- B.
Hypoperfusion of tissues.
- C.
Hypoxemia
- D.
All of the above.
- 4.
- A.
Cytokines act directly on target cells and may potentiate the actions of one another.
- B.
Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.
- C.
Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.
- D.
Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates
- 5.All of the following are true about neurogenic shock except:
- A.
There is a decrease in systemic vascular resistance and an increase in venous capacitance.
- B.
Tachycardia or bradycardia may be observed, along with hypotension.
- C.
The use of an alpha agonist such as phenylephrine is the mainstay of treatment
- D.
Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
- 6.
- A.
Dobutamine
- B.
Sodium nitroprusside.
- C.
Pneumatic antishock garment.
- D.
Intra-aortic balloon pump
- 7.
- A.
There are no primary alterations in cardiovascular signs
- B.
Signs of increased intracranial pressure may be masked by the hyponatremia.
- C.
Oliguric renal failure is an unlikely complication
- D.
Rapid correction of the hyponatremia may prevent central pontine injury
- E.
This patient is best treated by restriction of water intake.
- 8.
- A.
The total extracellular fluid volume represents 40% of the body weight.
- B.
The plasma volume constitutes one fourth of the total extracellular fluid volume
- C.
Potassium is the principal cation in extracellular fluid.
- D.
The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid
- E.
The interstitial fluid equilibrates slowly with the other body compartments.
- 9.1. Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
- A.
The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.
- B.
With normal renal function, this patient is likely to be volume overloaded.
- C.
Proper fluid therapy would be unlikely to include potassium administration
- D.
Insulin administration will increase the potassium content of cells.
- E.
Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.
- 10.Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
- A.
Age over 70 years.
- B.
Chronic malnutrition.
- C.
Controlled diabetes mellitus.
- D.
Long-term steroid use.
- E.
Infection at a remote body site.
- 11.
- A.
Myocardial infarct 4 months previously.
- B.
Clinical evidence of congestive heart failure in a patient with 8.5 gm. per dl. hemoglobin.
- C.
Premature atrial or ventricular contractions on electrocardiogram
- D.
A harsh aortic systolic murmur.
- E.
Age over 70 years.
- 12.
- A.
Whole blood is the most commonly used red cell preparation for transfusion in the United States.
- B.
Whole blood is effective in the replacement of acute blood loss.
- C.
Most blood banks in the United States have large supplies of whole blood available.
- D.
The use of whole blood produces higher rates of disease transmission than the use of individual component therapies
- 13.
- A.
Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.
- B.
Two units of FFP should be given with every 5 units of packed red blood cells in most cases
- C.
A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.
- D.
One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.
- E.
One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.
- 14.The evaluation of a patient scheduled for elective surgery should always include the following as tests of hemostasis and coagulation:
- A.
History and physical examination.
- B.
Complete blood count (CBC), including platelet count
- C.
Prothrombin time (PT) and activated partial thromboplastin time (APTT).
- D.
Studies of platelet aggregation with adenosine diphosphate (ADP) and epinephrine
- 15.
- A.
An allergic reaction.
- B.
An anaphylactoid reaction.
- C.
A clerical error.
- D.
An acute bacterial infection transmitted in blood.
- 16.
- A.
This formulation is proposed for the use of patients with fulminant hepatitis
- B.
Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.
- C.
The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy
- D.
In some studies of surgical patients, improvements in mortality have been reported.
- 17.
- A.
Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow
- B.
In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.
- C.
Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition
- D.
Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.
- 18.
- A.
In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated
- B.
In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.
- C.
In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.
- D.
CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support
- 19.
- A.
Gallstones occur with the same frequency in diabetes patients as in the healthy population.
- B.
The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.
- C.
Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.
- D.
The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.
- E.
Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.
- 20.
- A.
Prevents the aggressive development of atherosclerosis in diabetic patients
- B.
Is not associated with unawareness of hypoglycemia.
- C.
Improves peripheral neuropathy
- D.
Improves established retinopathy and nephropathy
- E.
Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).
- 21.What is the major determinant in an individual patient's risk for perioperative complications?
- A.
The surgical procedure.
- B.
The length of the surgical procedure.
- C.
The anesthetic technique (e.g., general, regional).
- D.
The length of anesthesia.
- E.
All of the above.
- 22.Advantages of epidural analgesia include:
- A.
Earlier mobilization after surgery.
- B.
Earlier return of bowel function.
- C.
Shorter hospitalizations.
- D.
Decreased stress response to surgery.
- E.
All of the above
- 23.
- A.
Protein depletion.
- B.
Infection
- C.
Anemia
- D.
Advanced age.
- E.
Hypoxia
- 24.
- A.
Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes
- B.
Lymphocytes are the primary blood cell involved with this process
- C.
The process involves a coating of the cytoplasmic surface known as clathrin
- D.
Phagocytosis is performed only by white blood cells and tissue macrophages
- 25.
- A.
The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration
- B.
The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium
- C.
The selectivity of biologic membranes is highly consistent and seldom changes
- D.
The selectivity of cell membranes relates only to ions and not organic compounds
- 26.
- A.
DNA is contained only in the nucleus of the cell
- B.
DNA strands are encoded by the sequence of four bases—adenine, guanine, cytosine and uridine
- C.
The basic unit of information of DNA is the intron, a sequence of three bases
- D.
There are an infinite number of possible codons
- 27.
- A.
The first step in gene transcription involves separating the double helix of DNA by an enzyme known as DNA polymerase
- B.
The initial product of DNA transcription is called heterogeneous nuclear RNA which codes directly for proteins
- C.
After processing is complete, the mRNA is exported from the nucleus to the cytoplasm
- D.
Only one protein can be produced from an initial mRNA strand
- 28.
- A.
The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 25% of preinjury weight
- B.
Under-nutrition may compromise the patient’s available defense mechanisms
- C.
Nutritional support is an immediate priority for the trauma patient
- D.
Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat
- 29.
- A.
Preoperative nutritional support should be provided to all patients with cancer
- B.
To be effective, preoperative nutrition must be given for at least two weeks preoperatively
- C.
Parenteral nutrition is the preferred route of feeding for all cancer patients
- D.
Standard total parenteral nutrition solutions maintain integrity of the small bowel
- E.
None of the above
- 30.
- A.
Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis
- B.
A major disadvantage of the peripheral technique is limited caloric delivery
- C.
If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site
- D.
Venous thrombosis is an uncommon complication for long-term central vein catheterization
- 31.
- A.
Glutamine is an essential amino acid
- B.
Glutamine appears to be of primary benefit in critical illness
- C.
Glutamine is included in most standard TPN solutions
- D.
Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon
- 32.
- A.
Since the patient’s weight had been stable with no preoperative nutritional deficit, 5% dextrose intravenous solutions are adequate for the initial postoperative source of nutrition
- B.
Preoperative immunologic status should be determined including total peripheral lymphocyte count and delayed hypersensitivity reaction to determine skin-test response to common antigens
- C.
Routine postoperative fluid administration with intravenous 5% glucose solutions can provide the calories to meet basal energy requirements
- D.
A jejunal feeding catheter should be placed at the time of surgery for postoperative enteral feeding
- 33.Which of the following statement(s) is/are true concerning the clinical management of an open wound?
- A.
A wet-to-dry dressing is the most optimal form of wound management
- B.
A moist occlusive dressing promotes epithelialization and reduces pain
- C.
The protein rich plasma exudate covering the open wound facilitates healing
- D.
Irrigation of the wound disrupts epithelialization therefore inhibiting the healing process
- 34.
- A.
Frequent surgical debridement is usually necessary
- B.
Water irrigation can effectively debride most wounds
- C.
Hydrogen peroxide is particularly useful in the management of open wounds
- D.
A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing
- 35.
- A.
Systemic antibiotics are indicated for all open wounds
- B.
Bacterial resistance can occur with systemic but not topical antibiotics
- C.
An indication for systemic antibiotic administration is a granulation tissue bacterial count in excess of greater than 105 organisms/gram of tissue on quantitative analysis
- D.
Silver sulfadiazine is useful only for the management of burns
- 36.Scar formation is part of the normal healing process following injury. Which of the following tissues has the ability to heal without scar formation?
- A.
Liver
- B.
Skin
- C.
Bone
- D.
Muscle
- 37.
- A.
Vitamin A supplementation
- B.
Vitamin C supplementation
- C.
Vitamin E application to the wound
- D.
Zinc supplementation
- E.
None of the above
- 38.
- A.
Keloids occur randomly regardless of gender or race
- B.
Hypertrophic scars and keloid are histologically different
- C.
Keloids tend to develop early and hypertrophic scars late after the surgical injury
- D.
Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention
- 39.
- A.
Vasoconstriction is an early event in the response to injury
- B.
Vasodilatation is a detrimental response to injury with normal body processes working to avoid this process
- C.
Vascular permeability is maintained to prevent further cellular injury
- D.
Histamine, prostaglandin E2 (PGE2) and prostacyclin (PGI2) are important mediators of local vasoconstriction
- 40.
- A.
Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications
- B.
A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding
- C.
Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy
- D.
A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal
- 41.
- A.
While IL-1 and TNFa share many biologic effects, IL-1 appears to be more potent
- B.
IL-1 expression is in part autoregulated
- C.
IL-1 inhibits prostaglandin production
- D.
The ability of IL-1 to upregulate endothelial cell-neutrophil adhesion molecules is relatively limited
- 42.
- A.
All antibodies are composed of one type of heavy and one type of light protein chain
- B.
The carboxyl terminus of the heavy chain is the antigen binding site
- C.
Antibody of the immunoglobulin G class is the initial antibody produced in response to an antigenic stimulus
- D.
Immunoglobulins A, D, and E play an active role in the circulating humoral response
- 43.
- A.
The issue of toxic side effects of antibiotics is only important in dealing with emperic therapy
- B.
Single agent therapy is generally inferior to specific multi-drug therapy (aminoglycoside plus an antianaerobic agent) for the treatment of secondary bacterial peritonitis due to appendicitis, diverticulitis, penetrating gastrointestinal injury, or anastomotic leak
- C.
With the empiric use of antibiotics, a diligent search for the septic source should be undertaken and continued until identified
- D.
In clinical situations in which polymicrobial infection is identified, specifically-directed treatment for the predominant organism is satisfactory
- 44.
- A.
Cytokines are produced solely by macrophages
- B.
Cytokines act only on other cells within the same local environment
- C.
Cytokines may have both protective and deleterious effects on the host
- D.
Each specific cytokine is produced by a single cell type
- 45.
- A.
The appropriate use of prophylactic antibiotics must include the initiation of the agent prior to the surgical procedure
- B.
Continuing the antibiotic into the postoperative period has led to improved results in antibiotic prophylaxis
- C.
The prophylactic administration of broad-spectrum agents (third-generation cephalosporins) has been shown to be particularly advantageous
- D.
The topical use of antimicrobial agents is of no advantage in the prophylactic setting
- 46.
- A.
Gut decontamination
- B.
Anti-LPS antibody
- C.
Anti-TNF antibody
- D.
Thymopentin
- E.
None of the above
- 47.
- A.
A fall in hematocrit or hemoglobin always accompanies hemorrhagic shock
- B.
The treatment of shock is generic regardless of the etiology
- C.
Pharmacologic intervention to increase myocardial contractility in hypovolemic shock is an important part the early management
- D.
Complications are less frequent after treatment of hemorrhagic shock than septic or traumatic shock
- 48.
- A.
The patient likely is suffering from hypovolemic shock and should respond quickly to fluid resuscitation
- B.
Beck’s triad will likely be an obvious indication of compressive cardiogenic shock due to pericardial tamponade
- C.
Echocardiography is the most sensitive noninvasive approach for diagnosis of pericardial tamponade
- D.
The placement of bilateral chest tubes will likely resolve the problem
- 49.
- A.
The low blood pressure can be assumed to be due to neurogenic shock
- B.
The sole cause of hypotension is the loss of sympathetic input to the venous system
- C.
Despite significant hypotension, secondary organ injury will be uncommon
- D.
There is no role for pharmacologic intervention to maintain blood pressure
- 50.
- A.
The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents
- B.
The circulatory derangements of septic shock precede the development of metabolic abnormalities
- C.
Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance
- D.
Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary
- 51.Which of the following statement(s) is/are correct concerning the immunoinflammatory response to shock?
- A.
The anaphylactoxins, C3a and C5a, are products of activation of only the classical pathway of the compliment cascade
- B.
Eicosanoids, such as prostaglandins are stored in platelets and endothelial cells and released in response to inflammatory stimuli
- C.
Thromboxane and PGI2 have similar effects
- D.
Platelet-activating factor can be released by both circulating and fixed tissue cells
- 52.Which of the following statement(s) is/are correct concerning the cardiovascular response to shock?
- A.
Changes in cardiac contractile function shift the Frank Starling curve up and down
- B.
Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock
- C.
Arterial vasoconstriction affects all vascular beds equally
- D.
The total circulating blood volume is equally split between the arterial and venous system
- 53.
- A.
A change in oxygen consumption is followed by a proportionate change in oxygen delivery
- B.
A change in oxygen delivery is followed by a change in oxygen consumption
- C.
Increases in oxygen delivery are due solely to an increase in cardiac output
- D.
The normal ratio of oxygen delivery to consumption is 2:1
- 54.Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema?
- A.
Diuresis and blood transfusion is a valuable step
- B.
Salt-poor albumin leaks through the capillaries and worsens the condition
- C.
Mannitol is contraindicated as a diuretic in this clinical situation
- D.
Isoproterenol is a poor choice as an ionotropic agent
- 55.
- A.
Conventional serum proteins such as albumin and globulin are early indicators of malnutrition
- B.
The total lymphocyte count reflects immune status and not nutrition
- C.
Antigen skin testing reflects patient immunity and not nutrition
- D.
Measurement of urea excretion in urine can be used as a measurement of protein breakdown
- 56.
- A.
Generalized increased capillary permeability
- B.
A hypermetabolic state
- C.
Organ malfunction
- D.
All of the above
- 57.
- A.
Pulmonary edema effectively narrows bronchi and increases pulmonary vascular resistance
- B.
Ventilation and perfusion are decreased equally
- C.
Positive pressure ventilation improves gas exchange by decreasing lung edema
- D.
The condition is frequently caused by decreased plasma protein levels
- 58.
- A.
Both the extracellular and intracellular components of total body water can be directly measured
- B.
The intravascular space accounts for the majority of extracellular fluid
- C.
All water in the interstitial space is freely exchangeable
- D.
Transcellular fluid, separated from other compartments by both endothelial and epithelial barriers, constitute about 4% of total body water
- 59.
- A.
Maximal renal compensation for metabolic acidosis occurs before full respiratory compensation can occur
- B.
All patients with lactic acidosis should receive prompt treatment with bicarbonate
- C.
Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis
- D.
Sodium bicarbonate administration should begin simultaneous with volume resuscitation in patients with hypoxia secondary to shock
- 60.
- A.
Narcotics have both profound analgesic and amnestic properties
- B.
Narcotics can cause hypotension by direct myocardial depressive effects
- C.
Naloxone should be used routinely for the reversal of narcotic analgesia
- D.
Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the use of narcotic analgesics
- E.
Propofol is a new intravenous short-acting narcotic used frequently in the outpatient setting
- 61.In “catabolic” surgical patients, which of the following changes in body composition do not occur?
- A.
Lean body mass increases.
- B.
Total body water increases.
- C.
Adipose tissue decreases.
- D.
Body weight decreases.
- 62.Narcotics are commonly used in the administration of general anesthesia. Which of the following statement(s) is/are true concerning this class of agents.
- A.
Narcotics have both profound analgesic and amnestic properties
- B.
Narcotics can cause hypotension by direct myocardial depressive effects
- C.
Naloxone should be used routinely for the reversal of narcotic analgesia
- D.
Acutely injured hypovolemic patients are at significant risk for decreased blood pressure with the use of narcotic analgesics
- E.
Propofol is a new intravenous short-acting narcotic used frequently in the outpatient setting
- 63.Which of the following statement(s) is/are true concerning the compensatory mechanisms and treatment of metabolic acidosis?
- A.
Maximal renal compensation for metabolic acidosis occurs before full respiratory compensation can occur
- B.
All patients with lactic acidosis should receive prompt treatment with bicarbonate
- C.
Potassium replacement is essential even in the face of normal or high serum potassium when treating diabetic ketoacidosis
- D.
Sodium bicarbonate administration should begin simultaneous with volume resuscitation in patients with hypoxia secondary to shock
- 64.Which of the following statement(s) is/are correct concerning the body fluid compartments?
- A.
Both the extracellular and intracellular components of total body water can be directly measured
- B.
The intravascular space accounts for the majority of extracellular fluid
- C.
All water in the interstitial space is freely exchangeable
- D.
Transcellular fluid, separated from other compartments by both endothelial and epithelial barriers, constitute about 4% of total body water
- 65.Which of the following statement(s) is/are true concerning pulmonary edema?
- A.
Pulmonary edema effectively narrows bronchi and increases pulmonary vascular resistance
- B.
Ventilation and perfusion are decreased equally
- C.
Positive pressure ventilation improves gas exchange by decreasing lung edema
- D.
The condition is frequently caused by decreased plasma protein levels
- 66.Intensive insulin therapy:
- A.
Prevents the aggressive development of atherosclerosis in diabetic patients
- B.
Is not associated with unawareness of hypoglycemia.
- C.
Improves peripheral neuropathy
- D.
Improves established retinopathy and nephropathy
- E.
Is indicated in all patients with non–insulin-dependent diabetes mellitus (NIDDM).
- 67.An important step in protein synthesis is transcription. Which of the following statement(s) is/are true concerning this process?
- A.
The first step in gene transcription involves separating the double helix of DNA by an enzyme known as DNA polymerase
- B.
The initial product of DNA transcription is called heterogeneous nuclear RNA which codes directly for proteins
- C.
After processing is complete, the mRNA is exported from the nucleus to the cytoplasm
- D.
Only one protein can be produced from an initial mRNA strand
- 68.Which of the following statement(s) is/are true concerning the role of glutamine in total parenteral nutrition?
- A.
Glutamine is an essential amino acid
- B.
Glutamine appears to be of primary benefit in critical illness
- C.
Glutamine is included in most standard TPN solutions
- D.
Glutamine is the primary energy source for intestinal mucosal cells of the small bowel and colon
- 69.Advantages of epidural analgesia include:
- A.
Earlier mobilization after surgery.
- B.
Earlier return of bowel function.
- C.
Shorter hospitalizations.
- D.
Decreased stress response to surgery.
- E.
All of the above
- 70.Which of the following statement(s) is/are true concerning the cell function of phagocytosis?
- A.
Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes
- B.
Lymphocytes are the primary blood cell involved with this process
- C.
The process involves a coating of the cytoplasmic surface known as clathrin
- D.
Phagocytosis is performed only by white blood cells and tissue macrophages
- 71.Which of the following statement(s) is/are true concerning the indications and administration of nutritional support to cancer patients?
- A.
Preoperative nutritional support should be provided to all patients with cancer
- B.
To be effective, preoperative nutrition must be given for at least two weeks preoperatively
- C.
Parenteral nutrition is the preferred route of feeding for all cancer patients
- D.
Standard total parenteral nutrition solutions maintain integrity of the small bowel
- E.
None of the above
- 72.Which of the following factors have been demonstrated to promote wound healing in normal individuals?
- A.
Vitamin A supplementation
- B.
Vitamin C supplementation
- C.
Vitamin E application to the wound
- D.
Zinc supplementation
- E.
None of the above
- 73.
- A.
Phagocytosis is a mechanistically distinct process of endocytosis performed by special cells to take up larger particles such as bacteria or erythrocytes
- B.
Lymphocytes are the primary blood cell involved with this process
- C.
The process involves a coating of the cytoplasmic surface known as clathrin
- D.
Phagocytosis is performed only by white blood cells and tissue macrophages
- 74.The characteristic changes that follow a major operation or moderate to severe injury do not include the following:
- A.
Hypermetabolism.
- B.
Fever
- C.
Tachypnea
- D.
Hyperphagia
- E.
Negative nitrogen balance.
- 75.Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true?
- A.
Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications
- B.
A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding
- C.
Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy
- D.
A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal
- 76.In patients receiving massive blood transfusion for acute blood loss, which of the following is/are correct?
- A.
Packed red blood cells and crystalloid solution should be infused to restore oxygen-carrying capacity and intravascular volume.
- B.
Two units of FFP should be given with every 5 units of packed red blood cells in most cases
- C.
A “six pack” of platelets should be administered with every 10 units of packed red blood cells in most cases.
- D.
One to two ampules of sodium bicarbonate should be administered with every 5 units of packed red blood cells to avoid acidosis.
- E.
One ampule of calcium chloride should be administered with every 5 units of packed red blood cells to avoid hypocalcemia.
- 77.A striking feature of living cells is a marked difference between the composition of the cytosol and the extracellular milieu. Which of the following statement(s) concerning the mechanisms of maintenance of these differences is/are true?
- A.
The cell membrane is able to maintain a 10,000 fold gradient between the extracellular concentration of ionized calcium and the intracellular concentration
- B.
The key to these differences is the fact that the plasma membrane is normally impermeable to sodium, potassium and calcium
- C.
The selectivity of biologic membranes is highly consistent and seldom changes
- D.
The selectivity of cell membranes relates only to ions and not organic compounds
- 78.Which of the following statement(s) is/are true concerning nutritional support of the injured patient?
- A.
The goal of nutritional support is maintenance of body cell mass and limitation of weight loss to less than 25% of preinjury weight
- B.
Under-nutrition may compromise the patient’s available defense mechanisms
- C.
Nutritional support is an immediate priority for the trauma patient
- D.
Fifty percent of non-nitrogen caloric requirements should be provided in the form of fat
- 79.Which of the following statements about the presence of gallstones in diabetes patients is/are correct?
- A.
Gallstones occur with the same frequency in diabetes patients as in the healthy population.
- B.
The presence of gallstones, regardless of the presence of symptoms, is an indication for cholecystectomy in a diabetes patient.
- C.
Diabetes patients with gallstones and chronic biliary pain should be managed nonoperatively with chemical dissolution and/or lithotripsy because of severe complicating medical conditions and a high operative risk.
- D.
The presence of diabetes and gallstones places the patient at high risk for pancreatic cancer.
- E.
Diabetes patients with symptomatic gallstones should have prompt elective cholecystectomy, to avoid the complications of acute cholecystitis and gallbladder necrosis.
- 80.1. Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
- A.
The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.
- B.
With normal renal function, this patient is likely to be volume overloaded.
- C.
Proper fluid therapy would be unlikely to include potassium administration
- D.
Insulin administration will increase the potassium content of cells.
- E.
Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.
- 81.A modified amino acid solution with increased equimolar branched-chain amino acids and decreased aromatic amino acids has been proposed for patients with hepatic insufficiency. Which of the following statements is/are true?
- A.
This formulation is proposed for the use of patients with fulminant hepatitis
- B.
Nitrogen balance is achieved in such patients with amounts of 40 gm. of amino acids per 24 hours.
- C.
The use of 80 to 100 gm. of such solutions is associated with hepatic encephalopathy
- D.
In some studies of surgical patients, improvements in mortality have been reported.
- 82.Glucose overload results in increased CO 2 production. Which of the following statements are true?
- A.
In patients with respiratory insufficiency, administration of glucose as a principal calorie source is contraindicated
- B.
In patients with pulmonary infection and sepsis, calorie support should consist of 95% fat and 5% glucose.
- C.
In Askanazi's study, increased CO 2 production and difficulty in weaning was associated only with pronounced overfeeding.
- D.
CO 2 production should be measured in most patients who are supported by respirators in intensive care units and are receiving nutritional support
- 83.Which of the following statement(s) concerning intravenous nutritional support is/are true?
- A.
Concentrations of glucose no higher than 5% should be used to avoid peripheral vein sclerosis
- B.
A major disadvantage of the peripheral technique is limited caloric delivery
- C.
If total parenteral nutrition is required, access to the superior vena cava via the external jugular vein is the most suitable site
- D.
Venous thrombosis is an uncommon complication for long-term central vein catheterization
- 84.Which of the following statement(s) is/are true concerning septic shock?
- A.
The clinical picture of gram negative septic shock is specifically different than shock associated with other infectious agents
- B.
The circulatory derangements of septic shock precede the development of metabolic abnormalities
- C.
Splanchnic vascular resistance falls in similar fashion to overall systemic vascular resistance
- D.
Despite normal mechanisms of intrinsic expansion of the circulating blood volume, exogenous volume resuscitation is necessary
- 85.Which of the following statement(s) is/are correct concerning the cardiovascular response to shock?
- A.
Changes in cardiac contractile function shift the Frank Starling curve up and down
- B.
Venoconstriction from skeletal muscle is a significant contributor to the restoration of blood volume with shock
- C.
Arterial vasoconstriction affects all vascular beds equally
- D.
The total circulating blood volume is equally split between the arterial and venous system
- 86.Which of the following statement(s) is/are true concerning the treatment of pulmonary interstitial edema?
- A.
Diuresis and blood transfusion is a valuable step
- B.
Salt-poor albumin leaks through the capillaries and worsens the condition
- C.
Mannitol is contraindicated as a diuretic in this clinical situation
- D.
Isoproterenol is a poor choice as an ionotropic agent
- 87.Which of the following statement(s) is/are true concerning the autoregulation necessary to maintain oxygen consumption and oxygen delivery?
- A.
A change in oxygen consumption is followed by a proportionate change in oxygen delivery
- B.
A change in oxygen delivery is followed by a change in oxygen consumption
- C.
Increases in oxygen delivery are due solely to an increase in cardiac output
- D.
The normal ratio of oxygen delivery to consumption is 2:1
- 88.Phases of multiorgan failure will include: Which of the following statement(s) is/are true concerning the assessment of protein reserve?
- A.
Conventional serum proteins such as albumin and globulin are early indicators of malnutrition
- B.
The total lymphocyte count reflects immune status and not nutrition
- C.
Antigen skin testing reflects patient immunity and not nutrition
- D.
Measurement of urea excretion in urine can be used as a measurement of protein breakdown
- 89.Which of the following statement(s) is/are correct concerning the management of an open wound?
- A.
Frequent surgical debridement is usually necessary
- B.
Water irrigation can effectively debride most wounds
- C.
Hydrogen peroxide is particularly useful in the management of open wounds
- D.
A number of the newer dressing products have clearly been shown to promote wound healing compared to simple moist occlusive dressing
- 90.Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
- A.
Age over 70 years.
- B.
Chronic malnutrition.
- C.
Controlled diabetes mellitus.
- D.
Long-term steroid use.
- E.
Infection at a remote body site.
- 91.Which of the following statements about extracellular fluid are true?
- A.
The total extracellular fluid volume represents 40% of the body weight.
- B.
The plasma volume constitutes one fourth of the total extracellular fluid volume
- C.
Potassium is the principal cation in extracellular fluid.
- D.
The protein content of the plasma produces a lower concentration of cations than in the interstitial fluid
- E.
The interstitial fluid equilibrates slowly with the other body compartments.
- 92.In the nutritional support of patients with cancer, which of the following statements is/are true?
- A.
Nutritional support benefits the patient's lean body mass but does not enable the tumor to grow
- B.
In experimental animals, the growth of implanted tumors is directly proportional to the amount of calories and protein supplied.
- C.
Prospective randomized trials of nutritional support utilizing chemotherapy and radiation therapy have revealed benefits to patients receiving total parenteral nutrition
- D.
Studies of nutritional support for patients with cancer about to undergo surgery revealed decreased morbidity and mortality, especially morbidity from sepsis.
- 93.1. Which of the following statements are true of a patient with hyperglycemia and hyponatremia?
- A.
The sodium concentration must be corrected by 5 mEq. per 100 mg. per 100 ml. elevation in blood glucose.
- B.
With normal renal function, this patient is likely to be volume overloaded.
- C.
Proper fluid therapy would be unlikely to include potassium administration
- D.
Insulin administration will increase the potassium content of cells.
- E.
Early in treatment adequate urine output is a reliable measure of adequate volume resuscitation.
- 94.Shock can best be defined as:
- A.
Hypotension
- B.
Hypoperfusion of tissues.
- C.
Hypoxemia
- D.
All of the above.
- 95.Which of the following statements regarding cytokines is incorrect?
- A.
Cytokines act directly on target cells and may potentiate the actions of one another.
- B.
Interleukin 1 (IL-1) is a major proinflammatory mediator with multiple effects, including regulation of skeletal muscle proteolysis in patients with sepsis or significant injury.
- C.
Platelet-activating factor (PAF) is a major cytokine that results in platelet aggregation, bronchoconstriction, and increased vascular permeability.
- D.
Tumor necrosis factor alpha (TNF-a), despite its short plasma half-life, appears to be a principal mediator in the evolution of sepsis and the multiple organ dysfunction syndrome because of its multiple actions and the secondary cascades that it stimulates
- 96.All of the following are true about neurogenic shock except:
- A.
There is a decrease in systemic vascular resistance and an increase in venous capacitance.
- B.
Tachycardia or bradycardia may be observed, along with hypotension.
- C.
The use of an alpha agonist such as phenylephrine is the mainstay of treatment
- D.
Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
- 97.Which of the following statements about head injury and concomitant hyponatremia are true?
- A.
There are no primary alterations in cardiovascular signs
- B.
Signs of increased intracranial pressure may be masked by the hyponatremia.
- C.
Oliguric renal failure is an unlikely complication
- D.
Rapid correction of the hyponatremia may prevent central pontine injury
- E.
This patient is best treated by restriction of water intake.
- 98.Which of the following is/are not associated with increased likelihood of infection after major elective surgery?
- A.
Age over 70 years.
- B.
Chronic malnutrition.
- C.
Controlled diabetes mellitus.
- D.
Long-term steroid use.
- E.
Infection at a remote body site.
- 99.Bleeding complications are frequently associated with fibrinolytic therapy. Which of the following statement(s) concerning complications of fibrinolytic therapy is/are true?
- A.
Careful monitoring of prothrombin time and aPTT time are necessary to avoid bleeding complications
- B.
A level of serum fibrinogen less than 100 mg/dl is associated with an increased risk of bleeding
- C.
Recent (less than 10 days) major surgery is a contraindication to systemic but not regional fibrinolytic therapy
- D.
A patient with a cerebrovascular event occurring less than two months ago can be treated with fibrinolytic therapy if head CT scan is normal
- 100.All of the following are true about neurogenic shock except:
- A.
There is a decrease in systemic vascular resistance and an increase in venous capacitance.
- B.
Tachycardia or bradycardia may be observed, along with hypotension.
- C.
The use of an alpha agonist such as phenylephrine is the mainstay of treatment
- D.
Severe head injury, spinal cord injury, and high spinal anesthesia may all cause neurogenic shock.
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